Long-term neuropsychological and psychosocial outcomes of decompressive hemicraniectomy following malignant middle cerebral artery infarctions

Purpose: This study examines long-term neuropsychological and psychosocial outcomes of survivors of malignant middle cerebral artery infarction treated via decompressive hemicraniectomy. Method: A case series design facilitated a detailed analysis of the outcomes among five participants. Neuropsychological domains assessed included premorbid and current IQ, sustained, selective and divided attention, visual and auditory memory, executive functioning and visuo-spatial ability. Psychosocial domains assessed included self-rated depression, anxiety and quality of life. Participants and their main carer were asked about their retrospective view of surgery. Results: All participants showed neuropsychological impairments in multiple cognitive domains, with preserved ability in others. Effects of laterality of brain function were evident in some domains. Clinically significant depression was evident in two participants. Overall quality of life was within average limits in three of four assessed participants. Four participants retrospectively considered surgery as having been a favourable course of action. Conclusion: While neuropsychological impairments are highly likely post-surgery, preserved abilities and social support may serve a protective function against depression and an unacceptably poor quality of life. Results do not support the suggestion that decompressive hemicraniectomy following malignant middle cerebral artery infarction necessarily leads to unacceptable neuropsychological or psychosocial outcomes.

Decompressive hemicraniectomy following malignant middle cerebral artery infarctions:a mixed methods exploration of carer experience and level of burden

Purpose: This study explores the experiences and sense of burden of family carers of survivors of malignant middle cerebral artery infarctions who had undergone decompressive hemicraniectomy. To date, there have been no studies examining carer outcomes among this unique population. This study, taken alongside an already published study of survivor outcomes, provides a more holistic picture with regard to sequelae within the sample. Method: Six family carers completed the Sense of Competence Questionnaire and the Hospital Anxiety and Depression Scale. These results were compared with existing normative data. Carers also consented to a semi-structured interview. Interview data were examined using thematic content analysis. Consistent with the mixed methods design, quantitative and qualitative findings were integrated for further analysis. Results: While carers experienced many losses, their overall sense of burden was not outside 'Average' limits, nor did they experience clinically significant symptoms of depression. All carers identified methods of coping with the demands of caregiving. These included intrapersonal, interpersonal and practical strategies. All carers apart from one were able to identify areas of post-traumatic growth. Conclusion: Carers will benefit from information, support and care. In addition, problem solving skills are essential in managing the myriad difficulties that arise in the aftermath of stroke. [Box: see text].

Middle Stone Age (MSA) site distributions in eastern Africa and their relationship to Quaternary environmental change, refugia and the evolution of Homo sapiens

This paper considers the evolution of Homo sapiens in eastern Africa in relation to refugia and bottlenecks around ~200 ka BP, at a macro scale. Middle Stone Age (MSA) lithics, site distributions and locations are analysed in relation to palaeovegetation maps of the last glacial/interglacial cycle, which are used as a proxy for earlier climate cycles. A ‘‘push and pull’’ model is then postulated for the spread of Homo sapiens out of refugia in eastern Africa, involving both volcanism (push) and habitat availability (pull). A date within OIS 5 is suggested for this expansion to other parts of the continent, and potentially further a?eld, contrary to a frequently proposed expansion within OIS 3. ©2008 Elsevier Ltd. All rights reserved.

How does involvement of a hospice nurse specialist impact on the experience on informal caring in palliative care? Perspectives of middle-aged partners bereaved through cancer

The aim of this study was to retrospectively explore partners' understandings and experiences in relation to caring for a loved one with a terminal illness, with a particular focus on the role of the hospice nurse specialist (HNS). Participants were purposively sampled and recruited through HNS gatekeepers. Seven middle-aged, bereaved partners participated in semi-structured, qualitative interviews. The interviews were audio recorded and transcribed verbatim and data were analysed using thematic content analysis. Five main themes emerged regarding the impact of the HNS on informal caring: ‘the ambivalence of caring’, ‘the HNS as a “confidante” in caring’, ‘the HNS as a “champion” in support’, ‘the work of the HNS – an unseen benefit’ and ‘being prepared for death and bereavement’. Findings from this study offer new insights into how involvement of a HNS impacts on the ability of carers to perform their role as an informal caregiver. Results highlight a crucial need for carers to have a clear understanding of all aspects of the HNS role so that full benefit is derived from their input. Recruitment of experienced and knowledgeable nurses is paramount, but equally important for carers is the supportive aspect of the role for which nurses need to demonstrate excellent communication skills and an intuitive, caring approach.

Man-in-the-Middle Attack Test-bed Investigating Cyber-security Vulnerabilities in Smart Grid SCADA Systems

The increased complexity and interconnectivity of Supervisory Control and Data Acquisition (SCADA) systems in the Smart Grid has exposed them to a wide range of cyber-security issues, and there are a multitude of potential access points for cyber attackers. This paper presents a SCADA-specific cyber-security test-bed which contains SCADA software and communication infrastructure. This test-bed is used to investigate an Address Resolution Protocol (ARP) spoofing based man-in-the-middle attack. Finally, the paper proposes a future work plan which focuses on applying intrusion detection and prevention technology to address cyber-security issues in SCADA systems.

Middle to late Holocene chironomid-inferred July temperatures for the central Northwest Territories, Canada

We analyzed subfossil chironomids, sediment organic matter and sediment particle size data from a 1.11-m-long freeze core collected from Carleton Lake (unofficial name), located approximately 120 km north of the modern treeline. This well-dated core spans the last ca. 6,500 years. Two chironomid transfer functions were applied to infer mean July air temperatures. Our results indicated that the chironomid-inferred temperatures from this lake sediment record did not pass a significance test, suggesting that other factors in addition to temperature may have been important in structuring the chironomid community through time. Although not statistically significant, the chironomid-inferred temperatures from this site do follow a familiar pattern, with highest inferred temperatures occurring during the Holocene Thermal Maximum (~6–4 cal kyr BP), followed by a long-term cooling trend, which is reversed during the last 600 years. The largest change in the chironomid assemblage, which occurred between ca. 4,600 and 3,900 cal yr BP is possibly related to the well-documented northward advance and subsequent retreat of treeline in this region.